Provider Demographics
NPI:1104317791
Name:LIN, ANDY TANG (MD)
Entity type:Individual
Prefix:
First Name:ANDY
Middle Name:TANG
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:919 WESTFALL ROAD, BUILDING C
Mailing Address - Street 2:STE 220
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:919 WESTFALL RD
Practice Address - Street 2:BLDG C STE 220
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2628
Practice Address - Country:US
Practice Address - Phone:585-341-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-20
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN713692084N0400X
NY3241472084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology